Haphephobia

Haphephobia is one of many specific phobias that indicates fear of being touched or touching others. People with haphephobia avoid being touched, and the fear, anxiety, or avoidance is so intense that distress and impairment in the individual’s school, work, or social functioning may result.

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, specific phobias fall under the class of anxiety disorders because they entail a significant fear or anxiety evoked by a specific object or situation. Phobias are often uncontrollable; persistent, typically lasting more than six months; and irrational. They are characterized by an intense fear or anxiety upon an encounter with the phobic object or situation. 

Haphephobia, pronounced haf-uh-fo-bee-uh, comes from the Ancient Greek words “haphḗ”, which means “touch”, and “phobia”, which means “fear.” 

Haphephobia, similar to other specific phobias, may occur as a result of traumatic experiences undergone to the individual or after observing someone else go through a traumatic event. Haphephobia is often induced by an event of sexual abuse or assault. Additionally, the underlying cause may be idiopathic, or without an identifiable cause. Temperament, genetic, and environmental factors may act as additional predisposing factors to developing haphephobia.

Signs and symptoms of haphephobia and other specific phobias may include signs of a panic attack, such as heart palpitations (i.e., pounding or racing of the heart), trembling, dizziness, chest pain, chills, sweating, nausea, hyperventilation, and difficulty breathing. Other symptoms include the feeling of being trapped or in danger, fear of loss of control, fear of dying, and feelings of detachment from oneself. In younger children, the presentation may involve crying, throwing a tantrum, or clinging to the parent or caregiver; while older children may develop rituals or repetitive intentional behaviors in response to the fear and may also avoid both the situation and their caregiver. Individuals experiencing specific phobias are usually aware their fear is excessive or irrational but are unable to control their response to it, do not respond to reassurance, and do almost anything to avoid exposure to the trigger. The phobia can also typically not be extinguished with distraction.

Depending on the severity of the condition and their response, the lives of individuals with specific phobias are affected to different degrees. An individual with severe haphephobia may avoid any situation in which there is a chance they’ll be touched, preventing them from forming relationships. For example, they will not go to a job interview to avoid having to shake the interviewer's hand, or they may refrain from going to a family event to avoid being hugged.

Haphephobia, as other specific phobias, must be medically reviewed to determine a diagnosis based on the DSM-5 criteria. The health care professional also assesses the situation through diagnostic interviews and self-report measures. They aim to determine the reason for the fear and avoidance, the variables that may influence the symptoms and their intensity, safety behaviors practiced in order to reduce anxiety, and more. In addition, the phobia must be distinguished from other similar conditions, such as panic disorder and posttraumatic stress disorder or typical fears, which differ from phobias.

Specific phobias, including haphephobia, are initially treated with cognitive behavioral treatment, or CBT. This includes cognitive and behavioral strategies aimed to reshape maladaptive thoughts and behaviors that sustain emotional distress. CBT may include several components, including psychoeducation, cognitive therapy, reduction of safety behaviors, and teaching of anxiety management techniques. However, the main component of CBT for specific phobias is exposure therapy. In vivo exposure, which is a type of treatment that entails participation in several sessions of repeated but gradual exposure to the fearful stimulus (e.g., touch) in a safe and controlled manner, is the most effective way to treat haphephobia. The goal of exposure therapy is to expose the individual to the stimulus, starting from encounters that produce less anxiety and advancing through more challenging experiences to reduce the associated anxiety in a stepwise fashion. A single, extensive session of exposure therapy has been proven to be useful in children.

When CBT with exposure therapy is not available or accessible or when the individual is unwilling to participate in this type of treatment, a benzodiazepine may be prescribed, but only as a short-term treatment and in very specific cases (e.g., when undergoing a medical examination that involves being touched by a medical professional). 

With proper and prompt treatment, haphephobia, as well as various other specific phobias, can be managed.

Haphephobia is a specific phobia that involves a persistent and extreme fear of touching or being touched. Diagnosis is based on the DSM-5 diagnostic criteria and thorough assessment to determine the best course of treatment. Cognitive behavioral therapy with exposure therapy is usually the most effective treatment option, while benzodiazepines may be utilized short-term and in specific cases.